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Unexpected conversion to thoracotomy during thoracoscopic lobectomy: a single-center analysis

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Abstract

Background

The aim of this study was to discuss indications and outcomes for conversion to thoracotomy during thoracoscopic lobectomy.

Materials and methods

Patients who underwent lobectomy for non-small cell lung cancer between January 2012 and December 2016 were evaluated retrospectively. The study included 129 patients who underwent video-assisted thoracoscopic lobectomy (group-V) and 18 patients converted from thoracoscopic lobectomy to thoracotomy due to unexpected intraoperative complications (group-T).

Results

The two patient groups showed no statistical differences in terms of demographic characteristics. Causes of unexpected conversions to thoracotomy were hemorrhage in six patients, dense pleural adhesions in seven patients, fused fissure in one patient, and fibrocalcified lymph nodes around the vascular structures in four patients. Operative time was 180.37 ± 68.6 min in group-V and 235 ± 72.6 min in group-T (p = 0.003). Intraoperative blood loss was 263.9 ± 180.6 mL in group-V, compared to 562.7 ± 296.2 mL in group-T (p < 0.001). Patient age ≥ 70 years was a significant risk factor for conversion to thoracotomy (p = 0.015, odds ratio 4.73). The 5-year survival rate in group-V was 71.4% {mean: 65.2 months [95% confidence interval (CI) 59.6–70.8]}, while that in group-T was 80% [mean 54.9 months (95% CI 45.9–63.8)] (p = 0.548).

Conclusion

Advanced age was identified as the main risk factor for conversion to thoracotomy. However, early- and long-term outcomes were similar in the two groups, indicating that video-assisted thoracoscopic surgery is a safe and applicable method.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey

    Celal Bugra Sezen, Salih Bilen, Levent Cansever, Yaşar Sonmezoglu, Umut Kilimci, Mustafa Vedat Dogru & Yunus Seyrek

  2. Department of Thoracic Surgery, Mardin State Hospital, 34020, Mardin, Turkey

    Cem Emrah Kalafat

  3. Department of Thoracic Surgery, Istinye University Medical Faculty, Liv Hospital Ulus, Istanbul, Turkey

    Celalettin Ibrahim Kocaturk

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  1. Celal Bugra Sezen
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  2. Salih Bilen
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  3. Cem Emrah Kalafat
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  4. Levent Cansever
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Correspondence to Cem Emrah Kalafat.

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Sezen, C.B., Bilen, S., Kalafat, C.E. et al. Unexpected conversion to thoracotomy during thoracoscopic lobectomy: a single-center analysis. Gen Thorac Cardiovasc Surg 67, 969–975 (2019). https://doi.org/10.1007/s11748-019-01127-1

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  • DOI: https://doi.org/10.1007/s11748-019-01127-1

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